Τίτλος:
Implantable cardioverter defibrillator therapy activation for high risk
patients with relatively well preserved left ventricular ejection
fraction. Does it really work?
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: Current guidelines for the primary prevention of sudden
cardiac death have used a left ventricular ejection fraction (LVEF) <=
35% as a critical point to justify implantable cardioverter
defibrillator (ICD) implantation in post myocardial infarction patients
and in those with nonischemic dilated cardiomyopathy. We compared
mortality and ICD activation rates among different ICD group recipients
using a cut-off value for LVEF <= 35%.
Methods: We followed up for a mean period of 41.1 months 495 ICD
recipients (442 males, 65.6 years old, 68.9% post myocardial infarction
patients, 422 with LVEF <= 35%). Prevention was considered primary in
patients who fulfilled guidelines criteria or had inducible ventricular
arrhythmia during programmed ventricular stimulation for patients with
LVEF >35%.
Results: Over the course of the trial, 84 of 495 patients died; 69
experienced cardiac death (6 sudden) and 15 non cardiac death. ICD
recipients with LVEF <= 35% compared to those with preserved LVEF (mean
LVEF=43%) had a greater incidence of totalmortality (18% vs. 11%, log
rank p=0.028) and cardiac death (15.4% vs. 5.5%, log rank p=0.005).
There was no difference in the incidence for appropriate device therapy
between patients with LVEF <= 35% and those with LVEF>35% (56.9% vs.
65.8%, log rank p=0.93). In the multivariate analysis the presence of
advanced New York Heart Association stage predicted both total mortality
(HR=2.69, 95% CI 1.771-4.086) and cardiac death (HR=3.437, 95% CI
2.163-5.463).
Conclusions: ICD therapy may protect heart failure patients at early
stages from arrhythmic morbidity and mortality, based on an
electrophysiology-guided risk stratification approach. (C) 2012 Elsevier
Ireland Ltd. All rights reserved.
Συγγραφείς:
Gatzoulis, Konstantinos A.
Tsiachris, Dimitris
Dilaveris,
Polichronis
Archontakis, Stefanos
Arsenos, Petros
Vouliotis,
Apostolis
Sideris, Skevos
Trantalis, George
Kartsagoulis,
Efstathios
Kallikazaros, Ioannis
Stefanadis, Christodoulos
Περιοδικό:
International Journal of Cardiology
Εκδότης:
Elsevier Ireland Ltd
Λέξεις-κλειδιά:
Implantable cardioverter defibrillator; Left ventricular ejection
fraction; Programmed ventricular stimulation
DOI:
10.1016/j.ijcard.2012.04.005
